FPA India Mumbai Branch, Biennial General Meeting held on August 10th ,2010
List of BEC Members (2010 & 2011)
1. Dr. Janaki Desai President
2. Dr. Shirish Malde Vice President
3. Dr. Kumud Nagral Vice President
4. Dr. Kamal Hazari Hon. Secretary
5. Mrs. Gulshan Kwatra Hon. Treasurer
6. Dr. K. Seshagiri Rao Hon. Treasurer
7. Dr. Archana Bhosale Member
8. Dr. Deepak Dave Member
9. Dr. Alka Gogate Member
10. Dr. Jayashree Joshi Member
11. Mr. Jessie Mistry Member
12. Dr. Sheela Naik Member
13. Dr. Sona Sethi Member
14. Ms. Salonie Murlidhara Youth Member
15. Mr. Gaurish Kadam Youth Member

Data Given by NRHM
Institutional deliveries increased 40.7% to 72.9%in India (CES-2009)

Health Camp for Adolescent Girls in Urban Slum of Mumbai.

Introduction
Adolescents constitute over 21.4% of the population in India. This age group (10-19 years) needs special attention because of the turmoil of adolescence which they face due to the different stages of development that they undergo, different circumstances they come across, their different needs and diverse problems. This period is very crucial since these are the formative years in the life of an individual when major physical, psychological and behavioral changes take place and additional roles and responsibilities are expected from them.1
Menarche is often considered as the central event of female puberty, from both medical and social perspectives, as it suggests the possibility of fertility. The average age of onset of the menstrual cycle varies from 11 years old or as late as 15. Menarche further calls for special attention because of the physical and emotional problems associated with it. Often they are not prepared for these changes due to cultural shyness, which are not addressed by parents, teachers, elders. Often they have misinformation which can lead to negative attitudes, fears and myths. The menstrual cycle is a normal monthly function of a healthy female body; the main concern is heavy bleeding, irregular cycles and pain during menses (dysmenorrhoea). 2 The psychological and emotional problems associated with menarche are of considerable magnitude and they may associate with nutritional problem among these girls. Anemia is the major nutritional deficiency often found in this group in India and other developing countries. Hence, the present programme was done with the objective of assessing the health problems amongst adolescent girls in slum areas of Mumbai (Central Mumbai) Maharashtra state.

Objectives

1.to find out the reproductive problems among adolescent girls in urban slum area.

2. to determine the prevalence of anemia among these adolescent girls by hemoglobin estimation

Material and Methods
The health camp was conducted among adolescent girls from urban slum and low-socio economic housing complexes in Worli, central Mumbai.
The following stages were involved in the selection of the group.

• A good rapport was developed with the Child Development Project Officer (CDPO), Mumbai Central, and Anganwadi workers of the Integrated Child Development Scheme (ICDS programme) to get an idea about the perceived health needs among adolescent girls in the areas
• The areas are defined into bits (one bit consisting of 20-25 Anganwadi centres). Out of the 6 bits, 2 bits were selected by Simple Random Sampling, from nearby Anganwadi centres. Three adolescent girls were selected from each Anganwadi.
• A total of 123 adolescent girls attended in the health camp. The data on age, height, weight, BMI and menstrual problems were obtained. The haemoglobin concentration was measured using Sahil’s method.

Measurements
History taking included general, medical, surgical procedures and menstrual history. General Examination including weight, Height, oral cavity, blood pressure in sitting position and chest auscultation, hemoglobin by Sahil’s method and blood group.

Height
Height in centimeters was marked on a wall with the help of a measuring tape. All girls were measured against this wall after removing their foot wear and ask to stand with heels together and their heads positioned so that the line of vision was perpendicular to the body.

Weight
Weight was recorded in kg without footwear.
Body Mass Index (BMI)
The body mass index (BMI) was calculated using the standard formula: BMI = Weight (kg)/Height 2 (m 2).

Haemoglobin
Hb was estimated by Sahil’s method using haemoglobinometer with blood obtained through finger prick (ring finger).

Results

• Out of 123 adolescent girls, most belonged to 10 and 14 years of age (74), followed by 15years (19), 16years (16), 17years (7), 18years (6) and 20 years (1) years of age.
• Out of 123 adolescent girls, 9 were in 12th class, 14 in class 11, 20 in class 10, 19 in class 9, 12 in class 8, 23 in class 7, 19 in class 6, 5 in class 5 and 2 in class 4.
• The height ranged between 117 and 162 cm.
• The weight ranged between21 and 61 kg.
• As per the WHO Criteria 34% (n=42) girls had normal BMI (18.5-24.9), 61% (n=75) girls were underweight (BMI<18.5), n="6)">
• Hemoglobin estimation revealed that 10% (n=12) had severe anemia i.e. Hb less than 8 gm %, 78% (n=96) had hemoglobin level between 8 and 10 gm% i.e. anemia while only 12% (n=15) had hemoglobin between 10 and 12gm%.
• Menarche was attained by 74 adolescents while 49 girls had not yet started with menses. Age of menarche among the above 74 girls ranged between 10 and 16 years of age. Eight girls had pain in abdomen/ Dysmenorhoea, muscle pain, headache and giddiness as symptoms before the onset of menstruation, 4 girls complained of irregular menses and rest 62 did not report any menstrual complaints. 4 girls had complaints suggesting Urinary Tract Infection, one girl had problem of disturbance of vision, one complained of acne on face and all girls respiratory normal.
• History suggestive of calcium deficiency was reported by one girl, four girls reported chest pain with cough and cold.
• On oral Examination for all the 123 adolescent girls. Dental hygiene was satisfactory for 83 girls while 40 girls had dental caries and were referred for dental treatment.

Treating Anemia

• History of worms taken but none of them could give answers
• Medical Doctors had given iron supplementary medicines with folic acid for one month in addition Calcium tablets were also given.
• Provided advice for iron rich diet green leafy vegetable, pulses & eggs etc.
• Regular health checks up.

Conclusion
The important observation as follows.

• 61% adolescent girls were undernourished (BMI-less than 18.5).
• 88 % anemic mainly due to of poor diet, heavy bleeding during menstruation & fashion trend of slimness.
• 33% Dental Caries is the commonest dental problem encountered
• 16% of 74 girls had menstrual problem.

Future Plan

• To organize sessions on nutrition for mothers and daughters.
• Education and information on general health and menstrual hygiene as interactive session for adolescent girls, mothers and Anganwadi teachers.

FAMILY PLANNING ASSOCIATION OF INDIA-MUMBAI BRANCH PERFORMANCE

Services Jan to Jun 2010

1. Counselling:- 17208


2. Safe Abortion:-1346


3. Female Sterilisation:-1680


4. Male Sterilisation:-5


5. IUDs:-473


6. Oral Contraceptives Pills:- 268


7. Other RH Services:- 2378


8. HIV/AIDS testing:-270


9. STIs/RTIs:- 419


10. Injectables(Depo-provera):-85


11. Condoms-Male:- 59


12. Emergency Contraception:-36


13. Cervical cancer screening:-273


14. Lab Investigation:-6532

Total Services:-31032

FAMILY PLANNING ASSOCIATION OF INDIA--MUMBAI BRANCH PERFORMANCE

Services 2009

1. Counselling:-19944
2. Safe Abortion:-2562
3. Female Sterilisation:-3269
4. Male Sterilisation:-8
5. IUDs:-832
6. Oral Contraceptives Pills:-428
7. Other RH Services:-2604
8. HIV/AIDS testing:-602
9. STIs/RTIs:-872
10. Injectables(Depo-provera):-187
11. Condoms-Male:-111
12. Cervical cancer screening:-183
13. Lab Investigation:-18225

Total services:-49827

Doctors meet" held at Kutumb Sudhar Kendra,FPAI Mumbai Branch.











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Dr.Raimalwala demonsrating "Vaginal Ring" during doctors meet.

NGO / CBO Meet 2010
FPA India, Mumbai Branch
1st Floor, Radhika Residency, Near Tilaknagar Railway Station, Mahatma Phule Nagar, CTS 46-B (PT), Tilaknagar (W), Mumbai – 400 089

NGO/CBO Meet for Networking:
FPA India Mumbai Branch organized an NGO/CBO Meet on June 18, 2010 at Avabai Wadia Health Center (AWHC), Tilak Nagar for experience sharing of JTF supported MSM Project achievements implemented during 2008 - 2010 and introduction of Positive Prevention among PLHIVs Project being implemented by FPA India Mumbai Branch during 2010–2012.
After welcome, the meeting began with the Power Point presentation on JTF funded MSM Project. Explaining the successful implementation of the Project Ms. Jugnu Doshi, Clinic Secretary, AWHC highlighted the co-operation and timely support extended by NGOs/CBOs working with the sexual minorities in capacity building of the Branch staff in providing quality SRH services to Sexual Minorities with greater sensitivity. She also referred to continued referral of MSMs by NGOs/CBOs, which had helped the MSM project to successfully serve 89 female partners of the MSM who were in need of sexual & reproductive health (SRH). She specially mentioned the timely support that the Project had received from Hum Safer Trust, Sakhi Char Choughi, Aarju Foundation and Udaan Secretariat. At the end of the presentation she informed that that integrated SRH services would continue to be provided to the sexual minorities in all the Branch clinics including the AWHC, which would start functioning soon.
Sharing his experience of working with FPA India Mumbai Branch MSM Project, Mr. Manoj Jani, President, Aarju Foundation appreciated the facilities created by FPA India Mumbai Branch for MSM and their female partners to access integrated SRH services. Creation of a friendly environment in FPAI Clinics having sensitised staff and not being branded to be serving only a particular kind of target groups helped a large number of married MSM and their female partners to avail services without stigma and discrimination. He informed that the Aarju Foundation would continue referring needy MSM and their female partners to FPA India Mumbai Branch Clinics for SRH services. Gouri Sawant, President, Sakhi Char Choughi also shared experiences of Sakhi Char Choughi clients especially Hijras/TG and the male sex partners of Hijras/TG availing SRH services at Branch Clinics without stigma. She also conveyed that Sakhi Char Choughi would continue to refer Hijras/TG and their male sex partners to Mumbai Branch clinics.
Mr. Shivaji Kare, Programme Manager, FPA India Mumbai Branch spoke about the Positive Prevention Project, the new initiative of FPA India Mumbai Branch for providing positive prevention services to PLHIV in Mumbai and Thane districts. Through a Power Point Presentation, he explained the objectives of Positive Prevention Project and conveyed that FPA India Mumbai Branch is committed to provide quality SRH services to the PLHIVs with the objective to cause delay in HIV disease progression and sought the support from all other NGOs working for PLHIVS.
Dr. Alka Gogate, FPA India Mumbai Branch Volunteer, and Ex-Project Director MDACS, highlighted the importance of networking to fulfill needs of sexual minorities. She pointed out that how big an organisation may be, it cannot on its own fulfill all the needs of PLHIVs. By way of illustration, she pointed out that the NGOs/CBOs who had been providing STI/HIV related services would not be able to provide ART, CD4 or SRH services She reiterated that each organization committed for certain aspect of services to HIV infected and affected persons, they would need to network and establish proper linkages with other organizations providing other services. She emphasiised that there is an urgent need for collective efforts for HIV prevention as well as care and support by various organizations working in these areas through proper networking and establishing linkages.
Dr. K. Seshagiri Rao, Vice President FPA India Mumbai Branch highlighted the need for ensuring community participation in meeting the needs of the PLHIVs and their sexual partners. He pointed out that each community whether a village community or a community of MSM or TG, will have its own specific needs. In most cases it would be difficult for one community to understand the needs of other community. Community participation approach helps the members of each community to become empowered to clearly think about the multiple needs of community members, express their requirements and seek support. Any NGO working for bringing about desirable changes in a community need to ensure that the community for which it would be working is actively involved through the process of empowerment. Community participation will contribute to identify the open and hidden needs of the community members, and develop the programmes to meet all those needs with the efforts of the members themselves, with the support of other communities and by networking for increased access to services as also for bringing about changes at the policy making as well as policy implementation levels. He shared the experience of FPAI in the application of community participation approach for increasing access to family planning services through women’s empowerment and male involvement.

Dr. Janaki Desai, President FPA India Mumbai Branch thanked all the NGOs/CBOs for the support they had been extending to FPA India Mumbai Branch in carrying out its various activities, particularly in serving the marginalized groups and appealed the participating in the meeting to continue their support for reaching out to such marginalized and under served groups including those with different sexual orientation. She assured that FPAI would continue to provide all the integrated services related to SRH and HIV under one roof and also networking with other NGOs for increasing accessibility of services and for carrying out advocacy with the Government on certain specific issues. She desired that FPA India Mumbai Branch and networking among the participating NGOs would lead to collective action that would to bring positive changes in the lives of sexual minorities and PLHIVs.

The open forum that followed brought out the following issues:
Issues to be addressed
Ø The number of ART centers available in Mumbai and Thane are inadequate when compared to the number of PLHIVs. The distance to be covered to reach the ART center particularly in Thane district is time consuming and economically costly. As a result, there are many defaulters among the PLHIV clients who are on ART.
Ø After care and support services are very limited in Mumbai. As a consequence, it is becoming very difficult for PLHIVs from High Risk Population, particularly with different sexual orientation to get admission in these centers.
Ø TGs find it difficult to access services in many of the hospitals as they cannot be classified either as Male or as Female. Male doctors are not comfortable because of their feminine nature; Female doctors are not comfortable because the male sexual origin.
Ø Community mobilisation efforts are needed for enabling PLHIVs and sexual minorities to raise their voice against stigma and discrimination for accessing the SRH services.
Agreement on some actions to be taken by NGOs
Ø NGOs should meet once a month to discuss various issues that are to be addressed based on the priority of the issue.
Ø It is desirable to have the monthly meeting of the networking NGOs on a Saturday
Ø Advocacy for provision of quality services to high risk groups without stigma and discriminations should be taken up with health service providers.
Ø Efforts should be made to increase accessibility of community, family and institution based care & support of the PLHIV to special groups like Hijras and orphan PLHIVs
Ø Sensitisation programmes are to be taken up for addressing the identity crisis of sexual minorities

Following NGOs and CBOs participated in the meet:
1. Network by People living with HIV in Mumbai (NPM+)
2. Sakhi Char Choughi Trust
3. Ekta Trust
4. CCDT
5. Network of Thane by People living with HIV (NTP+)
6. Sanjeevani
7. Sweekar Foundation
8. Humsaya Welfare Sanstha
9. Udaan Secretariat
10. Aarzu Foundation
11. Lawyers Collective